ADVANCED Professionals Inc.
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Executive Search Division, FL, United States
Director of Case Management
Case Management Director-VP
Miami, FL, United States
# of Beds:
Minimum of 5 years of utilization review, case management, discharge planning, social work, and/or other cost/quality management program experience. Knowledge of leading practice in clinical care and payer requirements. Knowledge of quality improvement processes. Working knowledge of managed care and of inpatient, outpatient, and the home health continuum. Working knowledge of InterQual and Milliman for medical necessity and appropriateness of care determination. Maintenance of current professional licensure in nursing or professional field of certification. Certification in case management is preferred. Demonstrated effective working relationship with physicians. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes. Must be able to maintain high-level confidentiality, have excellent writing skills, understand medical terminology, and be computer literate (word processing and other relevant software.) Any appropriate combination of relevant education, experience and/or certifications may be considered.
The Director of Utilization Review and Care Coordination (UR/CC) is responsible for care management, social services, utilization review , care coordination, patient resources utilization, and transitions care. The Director of UR/CC actively supports the mission and objectives of the hospital with a specific focus on Optimizing patient flow and maximizing efficient use of resources before, during, and after a patient's admission at UMH. The Director of UR/CC collaborates with hospital and clinical leadership to develop and implement strategic UR/CC services goals and objectives. This will all be accomplished in collaboration with the Associate Chief Medical Office for UR/CC (ACMO UR/CC) and in close consultation with the pertinent department heads and the medical executive leadership. The Director of UR/CC has a reporting relationship to the Executive Director of UR/CC. The Director of UR/CC accomplishes his/her role through the supervision and coordination of administrative, technical, investigative, and clerical operations of the Department UR/CC to assure maximum effectiveness and efficiency.